dyspepsia Flashcards
what is dyspepsia?
a term used to describe a complex of upper GI tract symptoms that are present for four or more weeks
include
- Upper abdo pain/ discomfort
- heartburn
- acid reflux
- nausea/vomiting
what are the most common causes for dyspepsia?
- GORD
- peptic ulcer disease
- functional dyspepsia
what should assessment of a person with unexplained dyspepsia include?
- ask about any alarm symptoms that may suggest complication/ underlying pathology
- ask about lifestyle factors and associated stress, anxiety and depression
- review medication including drugs that can cause/exacerbate dyspepsia e.g NSAIDs
- consider alternative diagnosis
- consider bloods for FBC to check for anaemia/raised platelet count, which may suggest underlying malignancy
what is the initial management of a person with unexplained dyspepsia?
- advice on lifestyle modification
- managing any associated stress, anxiety and depression
- reducing/stopping any drugs that may cause or exacerbate dyspepsia
following initial treatment, if symptoms persist what should be done?
1) full dose PPI should be prescribed for 1 month OR testing for H pylori infection should be arranged if status is still uncertain
2) alternative acid supression therapy can be considered with Histamine receptor antagonist (H2RA) can be considered
3) long term acid suppression therapy can be considered if symptoms have previously responded
what test is used for H pylori?
a carbon-13 urea breath test or stool antigen test should be used, make sure the person has not taken a PPI in the past 2 weeks, or antibiotics in the past 4 weeks.
if they test positive for H pylori, first line eradication therapy should be offered
how would you monitor people on long term treatment for uninvestigated dyspepsia ?
offer annual review
encourage to step down or stop treatment if possible and appropriate
what is univestigated dyspepsia?
‘Uninvestigated’ dyspepsia describes symptoms in people who have not had an endoscopy.
when should referral for an endoscopy or a gastroenterologist be considered?
- there are refractory or recurrent symptoms despite optimal management in primary care
- treatment with second line H pylori eradication regimen has been unsuccessful
- there are limited antibiotic options for H pylori eradication therapy
what is post prandial distress syndrome?
which is characterised by meal-induced dyspeptic symptoms, such as discomfort, pain, nausea, and fullness
what is epigastric pain syndrome?
refers to epigastric pain, or epigastric burning, that does not occur exclusively post-prandially, can occur during fasting, and can even be improved by meal ingestion
what is overlapping epigastric pain syndrome and post prandial distress syndrome?
characterised by meal-induced dyspeptic symptoms and epigastric pain or burning.